RHYTHM MANAGEMENT IN ATRIAL-FIBRILLATION - WITH A PRIMARY EMPHASIS ONPHARMACOLOGICAL THERAPY - PART 3

Atrial fibrillation (AF) is the most common, sustained, symptomatic ta chyarrhythmia that clinicians are called upon to manage. Management st rategies include ventricular rate control coupled with anticoagulation , versus restoration and maintenance of sinus rhythm. Rate control may be achieved pharmacologically with agents that impair AV nodal conduc tion directly and/or by increasing parasympathetic/sympathetic balance , or by modifying or ablating the AV nodal region anatomically. Rhythm control may be achieved by electrical or pharmacologic conversion fol lowed by maintenance of sinus rhythm by pharmacologic (or occasionally ablative) therapies. This article will present current approaches to rate and rhythm control issues in atrial fibrillation. Parts 1 and 2, published previously, dealt with rate control and with the restoration of sinus rhythm. Part 3, the current article, details the selection p rocess of choosing a therapy to maintain sinus rhythm, including the l ikelihood of success, the risks of therapy, and individualization of t herapy as dependent upon the nature of the structural heart disease pr esent. It also discusses nonpharmacologic approaches that have been re cently developed or are undergoing development. One suggested drug sel ection algorithm is provided.